Heart Care

Heart Failure Hospital Admissions Continue to Rise

The number of Americans admitted to hospitals for heart failure has jumped in recent years, and the trend almost certainly will continue, says a report in the Journal of the American College of Cardiology.

"Our study covers more than two decades, from 1979 to 2004, and the number of hospitalizations almost tripled during that time," says Dr. Jing Fang, an epidemiologist with Centers for Disease Control and Prevention (CDC).

A major reason for the increase is the aging of the American population, says Dr. Fang. Heart failure, in which the heart progressively loses its ability to pump blood, is more common among older people.

"Another reason is the improvement in technology for treatment of patients with other heart diseases, such as acute myocardial infarction [heart attack]," adds Dr. Fang. "So, people with diseases of the heart live longer."

Therapy Limited for a Declining Heart

The National Heart Discharge Survey shows that the number of admissions to hospitals with any mention of heart failure rose from over one million in 1979 to nearly four million in 2004, the report says.

More than 80 percent of those admitted to hospitals were 65 or older, with Medicare or Medicaid covering the cost.

The report did not cover the cost of the hospitalizations, but the American Heart Association has estimated it to be more than $20 billion annually, says Dr. Fang.

There has been a marked increase in the number of hospitalizations for which heart failure was not the primary cause.

Heart failure was listed as the primary cause in no more than 35 percent of cases, with respiratory diseases and other conditions given as the reason for hospital admission in all other cases.

"Most are due to pneumonia or another disease that makes heart failure worse," says Dr. Fang.

Better control of those other conditions, which include diabetes and kidney disease, could reduce hospitalizations for heart failure.

But those people tend to keep coming back to the hospital because "you cannot cure people with heart failure," explains Dr. Fang. "The best medicine [we] can do is to keep the heart functioning enough for the patient to have good quality of life."

Hospital-Based Care Could Improve

A basic problem is that there is no effective treatment for heart failure severe enough to cause hospitalization, says Dr. Javed Butler, director of the heart failure research program at Emory University in Atlanta, and co-author of an accompanying editorial.

"When you are talking about medications that have been proven, they all are for chronic, stable outpatients," explains Dr. Butler. "We don't have any proven medications for treatment in the hospital."

What is needed is a major effort to develop in-hospital treatments for severe heart failure, he says.

"When you consider the huge cost, it is right up high on the list of conditions we need to study," says Dr. Butler. "It is a least-studied, most costly problem. We need to get a better grasp on what we should be doing."

Always consult your physician for more information.

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Heart failure interferes with the kidney's normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid - resulting in swelling of the ankles and legs. Fluid also collects in the lungs - resulting in shortness of breath.

The following are the most common symptoms of heart failure:

shortness of breath during rest, exercise, or lying flat

weight gain

visible swelling of the legs and ankles (due to a build-up of fluid), and, occasionally, the abdomen

fatigue and weakness

loss of appetite and nausea

persistent cough - often produces mucus or blood-tinged sputum

reduced urination

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been lost.

The symptoms of heart failure may resemble other conditions or medical problems.